Healthcare Provider Details

I. General information

NPI: 1013112721
Provider Name (Legal Business Name): STEPHANIE K LIU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2007
Last Update Date: 09/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10940 SW BARNES RD # 375
PORTLAND OR
97225-5368
US

IV. Provider business mailing address

10940 SW BARNES RD #375
PORTLAND OR
97225
US

V. Phone/Fax

Practice location:
  • Phone: 646-591-7011
  • Fax:
Mailing address:
  • Phone: 973-972-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberA259510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: